use of pharmacogenetics to select erbitux or cisplatin to treat head and neck cancer

Conditions: Head and Neck Squamous Cell Cancer

Summary: this study is for patients with newly diagnosed head and neck cancer that cannot be removed by surgery. the purpose of this study is to determine the feasibility of using genetic variations in patients to select the right drug to treat head and neck cancer. cisplatin and cetuximab (erbitux)are both approved by the fda to treat head and neck cancer in combination with radiation therapy. in this study the investigators will test whether genetic differences between patients can be used to pick which of these two drugs a patient should receive. all patients will have a blood sample drawn that will be tested for genetic differences. if patients have genetic differences that correlate with a better outcome from cisplatin they will receive cisplatin with radiation. if patients have genetic differences that do not correlate with a better outcome from cisplatin they will receive cetuximab with their radiation therapy.

treatment-naive patients with locally advanced, non-metastatic (stage iii to ivb) squamous cell carcinoma of the head and neck who are candidates for concurrent chemoradiotherapy as primary therapy with curative intent will be enrolled. patients will be genotyped for germline variations at four snp loci in three genes involved in dna nucleotide excision repair (ercc1, ercc2, and xrcc1). patients with 3 to 8 variants will receive cisplatin (arm a). patients with 2 or fewer variants will receive cetuximab (arm b). the hypothesis of the study is that prospectively testing patients for variations in dna repair enzymes to determine whether to use cisplatin or cetuximab in locally advanced head and neck squamous cell cancer is feasible.

Eligibility criteria:
inclusion criteria: * biopsy proven squamous cell carcinoma of the head and neck, including the oral cavity, oropharynx, hypopharynx, or larynx, but not including primary tumors of the nasopharynx, sinuses, or salivary glands. * locally advanced, stage iii to ivb disease, and a candidate for primary therapy using chemotherapy and radiation therapy with curative intent. * patients with a diagnosis of 'unknown primary' will be eligible if chemoradiotherapy is the primary modality of treatment * no previous chemotherapy, radiation, or surgery for their diagnosis of head and neck cancer * eastern cooperative oncology group performance status \</= 1 * women of child-bearing potential must have a negative pregnancy test within 30 hours before initiation of study drug dosing. female subjects of reproductive potential must agree to avoid pregnancy throughout the study and for up to 3 months following discontinuation of study drug. male subjects must agree to avoid conceiving a child throughout the study and for up to 3 months following discontinuation of study drug; * hemoglobin \>/= 8.0 gm/dl * absolute neutrophil count \>/= 1500 * platelet count \>/= 100,000 * glomerular filtration rate \> 50 ml/min calculated by the cockcroft-gault equation * total bilirubin \</= 2.0 times the upper limit of normal unless the patient has gilbert's syndrome * aspartate aminotransferase and alanine aminotransferase \</= 2.5 times the upper limit of normal * no other current malignancy, other than basal cell skin cancer, squamous cell skin cancer, in situ cervical cancer, ductal or lobular in situ of the breast. patients with other malignancies are eligible if they have been continuously disease-free for \>/= 3 years prior to screening for this protocol. * age of 18 or older * ability and willingness to give informed consent * subjects must in the opinion of the investigator be capable of complying with this protocol. exclusion criteria: * acute treatment for an infection or other serious medical illness within 14 days prior to study entry * major surgery within 3 weeks prior to study entry * known hypersensitivity to cisplatin or cetuximab * patients who have any severe or uncontrolled medical conditions or other conditions that could affect their participation in this study, including: unstable angina, serious uncontrolled cardiac arrhythmia, active acute or uncontrolled infectious disorder, or myocardial infarction \</= 6 months prior to study entry. * female patients who are pregnant or breast feeding, or adults who are of reproductive potential and are unwilling to refrain from conceiving a child during study treatment. * patients unwilling to comply with the protocol, or provide informed consent * psychiatric illness that would limit compliance with study requirements

Keywords: head and neck cancer genetic testing cisplatin erbitux radiation therapy